摘要
目的探讨下眼睑下至手术导致术后眼睑内翻倒睫的原因和治疗方法。方法收集2015年1月至2019年12月就诊于首都医科大学附属北京同仁医院眼科中心因行下眼睑下至术并发下睑内翻倒睫的患者18例(36只眼)进行研究。患者均为女性,年龄20-40岁,平均年龄(28.5±5.81)岁。询问病史,查看原下睑下至术前照片以确定是否存在下睑赘皮和原手术入路。检查患者在坐位和卧位时下睑倒睫的范围和角膜损伤的情况,并根据下睑内翻倒睫的范围分为轻度、中度及重度三种类型。手术矫正采用下睑全长切口,去除适量皮肤、眼轮匝肌及睑板前脂肪,睫毛翻转缝合,皮肤切口行连续锁边缝合。术后随访6个月,观察患者坐位和卧位时下睑睑缘的位置和睫毛的方向,并观察术后的复发率。观察指标采用眼数和百分比进行描述。结果18例(36只眼)患者原下睑下至的术式,分别为经结膜入路者有10例(20只眼),占55.6%(20/36);经皮肤入路者有4例(8只眼),占22.2%(8/36);经结膜联合皮肤入路者有4例(8只眼),占22.2%(8/36)。其中,轻度、中度及重度下睑内翻倒睫者分别有6例(12只眼)、7例(14只眼)及5例(10只眼),分别占33.3%(12/36)、38.9%(14/36)及27.8%(10/36)。原术前存在轻度下睑赘皮及下睑睫毛生长方向异常者有6例(12只眼),占33.3%(12/36)。下睑下至术后下睑仍呈现多余的获得性下睑赘皮和睑板前眼轮匝肌肥厚,下睑的后层组织过度的下移而前层组织相对上移的患者有18例(36只眼),占100%(36/36);下眼睑下至联合自体脂肪填充术导致下眼睑前后层连接不紧密者有6例(12只眼),占33.3%(12/36);采取下眼睑外侧局部1/3皮肤切口,仅在外侧切口处切除部分皮肤和眼轮匝肌致下睑内侧呈获得性下睑赘皮性倒睫者有8例(16只眼),占44.4%(16/36)。经矫正术治疗后所有患者的倒睫得以矫正,角膜刺激性症状消失,角膜上皮损伤恢复,随访6个月均无下�
Objective To explore the reason and treatment of postoperative entropion caused by lowering the lower eyelid operation.Methods From January 2015 to December 2019,18 cases(36 eyes)with lower eyelid entropion were collected in the Beijing Tongren Eye Center,Beijing Tongren Hospital affiliated to Capital Medical University.They were all female with average age of(28.5±5.81)years-old(ranged from 20 to 40 years-old).The medical history and the specific operation methods of lowering the lower eyelid were asked in detail.According to the original lower eyelid down,the preoperative photo and primary surgical approach,patients were diagnosed whether there was lower eyelid epicanthus.The range of lower eyelid trichiasis was observed in sitting position and recumbent position,respectively.According to the range of lower eyelid entropion,it was divided into three types:mild,moderate and severe.Using the lower eyelid full-length incision was to correct;the lower eyelash,the excess skin,orbicularis oculi muscle and pretarsal fat were removed;the eyelash was rotated and sutured;and the skin incision was sutured continuously by lock edge.The patients were followed up for 6 months after operation,and the recurrence rate of lower eyelid entropion ciliary correction was observed using the position of lower eyelid margin and the direction of eyelashes in sitting and lying positions,respectively.The observation parameters were described by the number of eyes and percentage.Results 18 patients(36 eyes)with lower eyelid entropion underwent lowering the lower eyelid.10 cases(20 eyes)with ransconjunctival approach was performed under the eyelid,accounting for 55.6%(20/36);4 cases(8 eyes)for transcutaneous approach,accounting for22.2%(8/36);4 cases(8 eyes)for transconjunctival combined skin approach,accounting for 22.2%(8/36).The number of mild,moderate and severe lower eyelid entropion patients were 6 cases(12 eyes),7 cases(14 eyes),and 5 cases(10 eyes),accounting for 33.3%(12/36),38.9%(14/36),27.8%(10/36),respectively.6 cases(12 eyes)w
作者
王越
周慧颖
侯志嘉
章征
Wang Yue;Zhou Huiying;Hou Zhi Jia;Zhang Zheng(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology&Visual Science,Beijing 100730,China;Department of Ophthalmology,Beijing Tiantan Hospital of Capital Medical University,Beijing 100070,China)
出处
《中华眼科医学杂志（电子版）》
2021年第3期134-139,共6页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
北京市医院管理局中心“登峰”计划专项经费资助项目(DFL20190201)。
